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Individual
TU LE
Active
Individual
TU LE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
110029
CA
122300000X
Dentist
DN1859538
MA
1223P0300X
Periodontics
Primary
42104
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/19/2022
Last updated
02/20/2026
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